Provider First Line Business Practice Location Address:
410 GLENN AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BLOOMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-784-1723
Provider Business Practice Location Address Fax Number:
570-784-8512
Provider Enumeration Date:
06/27/2005